Surgical Procedures for Cirrhosis

Procedures for Managing Cirrhosis

Esophageal varices
are similar to varicose veins except that they occur in the lining of the walls of the lower esophagus (swallowing tube). They are a common complication of cirrhosis. If the veins rupture, they can cause serious bleeding that often requires blood transfusion. Once bleeding is controlled, treatment focuses on preventing future bleeding episodes. Ruptured esophageal varices are responsible for a large proportion of the deaths associated with cirrhosis.

Band Ligation

Endoscopy, which consists of a narrow tube mounted with a video camera being inserted into the throat, is used to identify the bleeding site. A rubber band is used to tie off the bleeding portion of the vein.

The TIPS procedure is the creation of an artificial connection directly between the portal veins and hepatic veins of your liver. The entire procedure is performed using needles, catheters, wires, and stents placed through a vein in your neck.

In this procedure, a catheter (tube) with a stent (a tube that shunts blood) attached to it is threaded through a vein in your neck into your liver. Using x-ray guidance, the stent is placed within your liver to allow blood to flow more easily through the portal vein. Once in place, the shunt allows blood to return directly to your heart without passing through the varices. TIPS is a good choice for bleeding that is not controlled by endoscopy.

Other Surgical Shunts

The splenorenal shunt helps to reduce the pressure within the variceal system by connecting the spleen vein to a kidney vein. On the other hand, portacaval shunt reduces pressure in the entire portal system by connecting the portal vein to the inferior vena cava.

These procedures are considered for people who:

Cannot be followed closely after TIPS

Are not a candidate for liver transplant

Have recurrent bleeding varices

Paracentesis

In this procedure, a soft catheter is inserted into the abdomen. Usually when large volumes of fluid are to be removed, human albumin is introduced into the abdominal cavity. Complications from this procedure include: catheter-related injury to the intestine, bleeding, infection, or a drop in blood pressure.

Liver Transplantation

During a liver transplant, a diseased liver is replaced with a healthy liver from a donor who has died. In some cases, a portion of the liver of a living, related donor may be used. Survival rates have improved because of drugs that suppress the immune system and keep it from attacking and damaging the new liver.

Endoscopic Sclerotherapy

Endoscopy is again used to identify the bleeding site. It is only useful if the bleeding is in your esophagus. A drug is injected into the bleeding vein, causing it to constrict. This slows the bleeding and allows a clot to form, closing the ruptured vessel. It is necessary to repeat the procedure over 2-3 months to reduce the risk of bleeding again. This procedure is rarely used.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

The Liver Transplant Surgery Program and Center for Liver Disease. University of Southern California website. Available at:
http://www.surgery.usc.edu/hepatobiliary/liversurgery.html. Accessed February 27, 2014.

Runyon BA. Management of Adult Patients with ascites Due to Cirrhosis: An Update.
Hepatology.
2009;49:2087-2107.